Why the U.S. Needs Better Postpartum Care — Now

You’ve just had your baby, and it feels like the hard part is over. You’ve settled back into your hospital room with a fresh postpartum gown on, the flowers are arriving, visitors are streaming in and you’ve got nothing but baby snuggles, some minor healing and a whole lot of snacks to look forward to, right?

Not exactly. The days and weeks postpartum are a critical time period in a new mom’s life. Why? Because it’s when the vast majority of maternal deaths occur — and it’s also one of the most understudied, under-funded and overlooked periods of a mom’s life. The U.S. needs better postpartum care, and it needs it fast.

The Postpartum Problem

Most of the focus after a woman gives birth in a hospital is on her new baby — not her. And before we go any further, it’s important to note that isn’t inherently a bad thing. The infant mortality rate in the U.S. actually just hit an historic low, dropping from 596 deaths per 100,000 in 2013 to 581 per 100,000 births in 2014. This, as Nina Martin wrote in her recent viral ProPublica article on maternal deaths, “[reflects] 50 years of efforts by the public health community to prevent birth defects, reduce preterm birth, and improve outcomes for very premature infants.” It’s good news — actually, it’s great news — that we’ve improved health outcomes for babies – period. But it’s worrisome that at a time when maternal mortality rates all around the world are decreasing, the maternal mortality rate is actually increasing in the United States.

One problem is that many hospitals are not properly equipped with staff, education or resources to adequately care for women in the postpartum stage. (In fact, a growing number of hospitals nationwide, particularly those in rural areas, don’t even have maternity wards.) Additionally, a recent study found that the majority of postpartum nurses either aren’t equipped to or don’t feel comfortable talking to new moms about the potential health risks they face postpartum, like blood clots, headaches and heart problems. It also found that only 12 percent of nurses knew that the maternal mortality rate in the U.S. was increasing; 24 percent reported knowing the leading cause of maternal death (heart-related problems).

Martin’s ProPublica piece, which focused on the story of 33-year-old New Jersey resident Lauren Bloomstein, recently raised the alarm for many people after she died from complications from preeclampsia following the delivery of her first child. Not only was Lauren’s husband a doctor, but she was a NICU nurse herself at the very hospital she delivered— the nurses and doctors caring for her were the very nurses and doctors she worked alongside with every day. And yet her entire medical team still missed the signs that she was in trouble: complaints of chest pain, rising blood pressure, restlessness and a general feeling that something was wrong.

Moreover, in the U.S., when a woman dies in childbirth or of a pregnancy-related cause, there is no standard procedure for how her death is treated. As ProPublica noted in its investigation, other countries, such as the U.K, treat maternal death like a system-wide failure and rigorously and publicly review data to determine at what exact point the system failed. But the U.S. allows each state to come up with its own system for handling maternal death — and according to ProPublica, only 26 states have some kind of maternal mortality review process in place. This means that a lot of those deaths fall through the cracks.

Changing the Focus

For a long time, the focus of maternal health care has been on getting to the finish line of a healthy baby, but there are still many risks, potential complications and medical issues that can arise after delivery, from infection to sepsis to blood clots, and it’s important that hospitals and medical staff are properly trained and ready for emergencies that happen after birth too.

Many times at larger hospitals, care for women who have just delivered a baby is divided into three separate sections: laboring women, delivery, and postpartum mother and baby care. The three separate care model allows nurses and care providers to be more focused on specialty care for each area, because they are all very different. For example, the needs of a woman in the early stages of labor are going to be vastly different than a mom who has just gone through an emergency C-section with twins and is trying to figure out breastfeeding.

At smaller hospitals, however, due to the facility’s capabilities, staff and room layout, it isn’t always possible to have nurses who are solely dedicated to caring for postpartum mothers. A nurse might be switching back and forth between caring for a few sets of moms and babies and also keeping an eye on a first-time mom who’s having early contractions but is not yet in active labor. What exactly does that mean? At a larger facility, a nurse might solely work on a postpartum unit, where she would receive more training and gain more experience in working with postpartum mothers, be more likely to pick up on any potential complications and have more time to educate mothers before discharge. A nurse who wears all three hats of labor, delivery and postpartum care — competent as she may be in all those areas — may not have as much time and training to go really in-depth into postpartum care and monitoring with her patients. When I was an OB nurse at a small hospital, where the nurses would provide all three aspects of care, it was easy to fall into the trap of prioritizing the seemingly all-consuming needs of women at delivery and feel like any immediate danger had passed in the hours after the baby was born.

When you combine a lack of training, education and resources in health care staff with the fact that many moms who have a vaginal birth are discharged within 24 hours to free up hospital space, it’s not surprising that postpartum maternal health complications are missed. Most women don’t even see a doctor until three to six weeks after delivery and 40 percent of new moms don’t see their doctor for a follow-up visit at all. We need to better educate new moms starting at the hospital so that they know what to look for when they go home.

What You Can Do

I wouldn't blame you if you were in a complete panic after reading this. It's important to know that despite the increasing maternal mortality rate, your individual chances of dying in childbirth or of pregnancy-related complications or of experiencing any kind of complication are still very low. You can also rest assured that most nurses and doctors take their jobs seriously and absolutely will work as hard as they can to provide the absolute best pre- and postnatal care for you.

But people make mistakes and systems sometimes fail. Until we reach a point where all doctors, nurses and health care providers are adequately trained, educated and prepared to care for moms after delivery, you are your own best advocate. Here are a few things you can do:

Know what you can control: One of the best ways to prevent postpartum complications is to enter pregnancy as healthy as possible, so if you’re planning to conceive soon, schedule a pre-conception check-up and talk to a doctor about any medical conditions you have that could pose a risk.

Always, always, always trust your intuition. One of the things that all of my senior nurses at the hospital always drilled into me was to listen when a mother said something was wrong or “off.” More often than not, that mom was right. If you feel like something is wrong, tell someone and don’t be afraid to push harder if you don’t receive help that you need.

Be your own health advocate. If at all possible, be aware of what’s going on with your care while you’re in the hospital or talk with a partner or support person before going into the hospital. Don’t be afraid to ask questions or request to talk to a doctor or a nurse. If you notice a high blood pressure reading, for example, and are concerned, you can absolutely get those concerns addressed.

Remember that you matter too. Yes, your baby’s health is important, but so is yours. Don't hesitate to speak up — a healthy baby and family starts with a healthy mom, so don’t ever feel like you should come last.